Establishment of standard renal channels in PCNL by Needle-perc system assisting for the treatment of kidney stones without hydronephrosis
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摘要: 目的:探讨针状肾镜Needle-perc系统辅助建立标准皮肾通道PCNL治疗无积水肾脏结石的安全性和有效性。方法:回顾性分析2018年3月—2020年8月在我院接受标准通道经皮肾镜碎石术的21例无积水肾结石患者的临床资料,其中完全鹿角型结石2例,不完全鹿角型结石7例,肾盂多发结石1例,上盏结石1例,中盏结石3例,下盏结石7例,结石中位最大长径2.5(1.6~4.9) cm(多发结石计算结石最大长径之和)。术中在超声引导下应用Needle-perc系统进行可视化穿刺、辅助建立皮肾通道。结果:21例患者手术均顺利完成,对19例患者实施单通道手术,2例患者实施双通道手术,F24标准通道均一期建立成功,中位手术时间80(50~175) min,术中无集合系统穿孔及肾脏周围脏器损伤等并发症;术后输血率4.7%(1/21),6例患者术后出现发热,给予静脉输注抗生素治疗。术后复查KUB显示一期结石清除率85.7%(18/21)。结论:针状肾镜Needle-perc系统可以降低PCNL无积水肾脏结石标准通道建立难度,有效减少该类患者通道建立相关并发症的发生。Abstract: Objective: To investigate the safety and effectiveness of Needle-perc assisting in establishing standard renal channels in the percutaneous nephrolithotomy(PCNL) for kidney stones without hydronephrosis.Methods: The clinical data of 21 patients with kidney stones without hydronephrosis who underwent standard renal channels PCNL from March 2018 to August 2020 were retrospectively analyzed. There were 2 complete staghorn stones and 7 incomplete staghorn stones. One case's stones were in upper calyces, three and 7 cases' stones were in middle and lower calyces respectively. The median diameter of stones was 2.5(1.6-4.9) cm(If there were multiple stones, the sum of the diameter of each stone was calculated). We used Needle-perc visual system to puncture the target renal calyces guided by the ultrasound and assist in establishing standard renal channels.Results: All surgeries were completed successfully. Single channel was established on 19 patients and dual channels on 2 patients. All F24 standard renal channels were established successfully. The median operation time was 80(50-175) mins. No patient experienced complications such as collecting system perforation or injury of adjacent organs. Rate of blood transfusion after surgeries was 4.7%(1/21). Six cases had fever after surgery and were treated with intravenous infusion of antibiotics. The KUB on the third day after surgery showed the stone clearance rate was 85.7%(18/21).Conclusion: Needle-perc can reduce the degree of difficulty of establishing standard renal channels in the PCNL for kidney stones without hydronephrosis and reduce the occurrence of complications related to channel establishment effectively.
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